In vivo forces on implants influenced by occlusal scheme and food consistency

PURPOSE: The aim of this study was to investigate whether systematic modifications of occlusal features or food consistency are suitable to reduce the loading of implants. MATERIALS AND METHODS: Ten healthy subjects, each of whom had a gap in the chewing center (second premolar or first molar) of one lateral dental arch, were provided with fixed partial dentures (FPD) on two ITI implants. Strain gauges attached to the abutments recorded forces in three dimensions. In each person, the original FPD was successively replaced by three FPDs with different occlusal schemes: The first had steep cusps, the second had flat cusps, and the third had the same cuspal inclination as the first but a narrow occlusal surface. Subjects chewed gummy bears and bread as a tough and a soft bolus, respectively. RESULTS: In chewing of gummy bears, the mean vertical forces of the three FPDs ranged between 264 and 284 N and were not significantly different. The mean bending moments amounted to 27 Ncm and 24 Ncm with steep and flat occlusal slopes, respectively. With the narrow occlusal surface, the bending moments were reduced by 48%, to a mean of 11 Ncm. Chewing of bread yielded similar relations with lower mean vertical forces and bending moments. CONCLUSION: Narrowing the orovestibular width of the occlusal surface by 30% caused a significant reduction of lateral force components. A reduced orovestibular width of the occlusal surface is recommended in unfavorable loading conditions. In addition, the chewing of soft food is suggested during the healing period in cases of immediate loading.     

ALL-CERAMIC AND PORCELAIN-FUSED-TO-METAL FIXED PARTIAL DENTURES: A COMPARATIVE STUDY BY 2D FINITE ELEMENT ANALYSES

All-ceramic fixed partial dentures (FPDs) have an esthetic approach for oral rehabilitation. However, metal-ceramic FPDs are best indicated in the posterior area where the follow-up studies found a lower failure rate. This 2D finite element study compared the stress distribution on 3-unit all-ceramic and metal-ceramic FPDs and identified the areas of major risk of failure. Three FPD models were designed: (1) metal-ceramic FPD; (2) All-ceramic FPD with the veneering porcelain on the occlusal and cervical surface of the abutment tooth; (3) All-ceramic FPD with the veneering porcelain only on the occlusal surface. A 100 N load was applied in an area of 0.5 mm² on the working cusps, following these simulations: (1) on the abutment teeth and the pontic; (2) only on the abutment teeth; and (3) only on the pontic. Relative to the maximum stress values found for the physiological load, all-ceramic FPD with only occlusal veneering porcelain produced the lowest stress value (220 MPa), followed by all-ceramic FPD with cervical veneering porcelain (322 MPa) and metal-ceramic FPD (387 MPa). The stress distribution of the load applied on the abutments was significantly better compared to the other two load simulations. The highest principal stress values were low and limited in a small area for the three types of models under this load. When the load was applied on the pontic, the highest stress values appeared on the connector areas between the abutments and pontic. In conclusion, the best stress values and distribution were found for the all-ceramic FPD with the veneering porcelain only on the occlusal surface. However, in under clinical conditions, fatigue conditions and restoration defects must be considered.     

Role of implant configurations supporting three‐unit fixed partial denture on mandibular bone response: biological‐data‐based finite element study

Implant‐supported fixed partial denture with cantilever extension can transfer the excessive load to the bone around implants and stress/strain concentration potentially leading to bone resorption. This study investigated the effects of implant configurations supporting three‐unit fixed partial denture (FPD) on the stress and strain distribution in the peri‐implant bone by combining clinically measured time‐dependent loading data and finite element (FE) analysis. A 3‐dimensional mandibular model was constructed based on computed tomography (CT) images. Four different configurations of implants supporting 3‐unit FPDs, namely three implant‐supported FPD, conventional three‐unit bridge FPD, distal cantilever FPD and mesial cantilever FPD, were modelled. The FPDs were virtually inserted to the molar area in the mandibular FE models. The FPDs were loaded according to time‐dependent in vivo‐measured 3‐dimensional loading data during chewing. The von Mises stress (VMS) and equivalent strain (EQS) in peri‐implant bone regions were evaluated as mechanical stimuli. During the chewing cycles, the regions near implant necks and bottom apexes experienced high VMS and EQS than the middle regions in all implant‐supported FPD configurations. Higher VMS and EQS values were also observed at the implant neck region adjacent to the cantilever extension in the cantilevered configurations. The patient‐specific dynamic loading data and CT‐based reconstruction of full 3D mandibular allowed us to model the biomechanical responses more realistically. The results provided data for clinical assessment of implant configuration to improve longevity and reliability of the implant‐supported FPD restoration.     

The Effect of Incorporation, Orientation and Silane Treatment of Glass Fibers on the Fracture Resistance of Interim Fixed Partial Dentures

Fracture of interim fixed partial dentures (FPD) is of important concern to the dental surgeon, especially with long-span fixed partial dentures or areas of heavy occlusal stress. Polymers used in interim FPDs, reinforced with glass fibers have shown to have a positive effect on the fracture resistance of interim FPDs. Since little research has been done on the influence of silane treated glass fibers on the fracture resistance of interim FPDs, this study was conducted to evaluate the effect of silane treatment of glass fibers on the fracture resistance of interim FPDs and its correlation with the position of fiber reinforcement and length of the span of the interim FPD. Interim FPDs were fabricated from an autopolymerizing polymethyl methacrylate (PMMA) resin. Seven FPDs were made in each group. The FPDs in the control group were unreinforced, and in the other groups the FPDs were reinforced either with non silane treated glass fiber or with silane treated glass fiber. The fibers were placed in two different locations in the FPDs. Three length of span of FPDs were tested. The load was applied to the FPD by a steel ball placed in the center of the pontic space. One Way Anova, Two Way Anova, Studentized range test (Scheffe’s). Results showed that the load required for fracturing the unreinforced FPDs varied from 272 to 998 N. Mean fracture load of reinforced FPDs varied from 536 to 1642 N. One-way analysis of variance showed that the position of fibers and the silane treatment fibers significantly affected the fracture load. The results of this study suggested that the silane treatment of glass fibers had a marked improvement in the fracture resistance of FPDs as compared to untreated glass fibers. Selective placement of the glass fibers at the undersurface of the pontic and the occlusal surface of the interim fixed partial denture showed more increase in the fracture resistance as compared to the randomly distributed glass fibers. The glass fiber reinforcement is effective in increasing the fracture resistance with the effectiveness most evident in interim FPDs with long spans. With increase in the length of span of interim fixed partial denture the fracture resistance was shown to decrease significantly in all the groups.     

The influence of implant location and length on stress distribution for three-unit implant-supported posterior cantilever fixed partial dentures

STATEMENT OF THE PROBLEM: The influence of implant location for an implant-supported cantilever fixed partial denture (FPD) on stress distribution in the bone has not been sufficiently assessed. PURPOSE: This study examined the influence of location and length of implants on stress distribution for 3-unit posterior FPDs in the posterior mandibular bone. MATERIAL AND METHODS: Each 3-D finite element model included an FPD, mesial and distal implants, and supporting bone. The mesial implant with a length of 10 mm or 12 mm was placed in locations where its long axis was 3 mm to 11 mm posterior to the remaining first premolar. The distal implant with a length of 10 mm was fixed at the same distance from the premolar on each model. A buccally-oriented oblique occlusal force of 100 N was placed on each occlusal surface of the FPD. RESULTS: The maximum equivalent stresses were shown at the cervical region in the cortical bone adjacent to the mesial or the distal implants. Relatively high stresses of up to 73 MPa were shown adjacent to the mesial implant located 9 mm or more posterior to the first premolar. The use of a 12-mm-long mesial implant demonstrated a relatively weak influence on stress reduction. CONCLUSION: The implant location in the cantilever FPDs was a significant factor influencing the stress created in the bone.     

Clinical performance of a lithia disilicate-based core ceramic for three-unit posterior FPDs

PURPOSE: The purpose of this research project was to determine the clinical success rate of a lithia disilicate-based core ceramic for use in posterior fixed partial dentures (FPD) as a function of bite force, cement type, connector height, and connector width. MATERIALS AND METHODS: Thirty ceramic FPD core frameworks were prepared using a heat-pressing technique and a lithia disilicate-based core ceramic. The maximum clenching force was measured for each patient prior to tooth preparation. Connector height and width were measured for each FPD. Patients were recalled yearly after cementation for 2 years and evaluated using 11 clinical criteria. All FPDs were examined by two independent clinicians, and rankings from 1 to 4 were made for each criterion (4 = excellent; 1 = unacceptable). RESULTS: Two of the 30 ceramic FPDs fractured within the 2-year evaluation period, representing a 93% success rate. One fracture was associated with a low occlusal force and short connector height (2.9 mm). The other fracture was associated with the greatest occlusal force (1,031 N) and adequate connector height. All criteria were ranked good to excellent during the 2-year recall for all remaining FPDs. CONCLUSION: The performance of the experimental core ceramic in posterior FPDs was promising, with only a 7% fracture rate after 2 years. Because of the limited sample size, it is not possible to identify the maximum clenching force that is allowable to prevent fracture caused by interocclusal forces.     

Narrow‐ (3.0 mm) Versus Standard‐Diameter (4.0 and 4.5 mm) Implants for Splinted Partial Fixed Restoration of Posterior Mandibular and Maxillary Jaws: A 5‐Year Retrospective Cohort Study

Background: Evidence concerning predictability of narrow‐diameter implants (NDIs) (<3.3 mm) to restore partially edentulous posterior maxillary and mandibular areas is limited. The aim of this study is to compare the 5‐year outcomes of NDIs (3.0 mm) and standard‐diameter implants (SDIs) (4.0 to 4.5 mm) supporting fixed partial dentures (FPDs) in posterior mandibular and maxillary jaws. Methods: All patients treated with at least two adjacent NDIs or SDIs according to available bone thickness and with a minimum follow‐up of 5 years after placement were invited to undergo a clinical and radiologic examination. Outcome measures were implant and FPD failures, biologic and prosthetic complications, and marginal bone loss. Results: A total of 107 out of 127 patients attended the examination: 49 (113 implants) of the NDI group, and 58 (126 implants) of the SDI group. Two NDIs failed in one patient versus four SDIs in four patients (P = 0.37). One FPD failed in the NDI group versus two FPDs in the SDI group (P >0.99). Nine biologic complications occurred in the NDI group and twelve in the SDI group (P = 0.81). Twelve prosthetic complications occurred in the NDI group and only two in the SDI group (P = 0.001). Peri‐implant marginal bone loss at 5 years was 0.95 ± 0.84 mm for the NDI group and 1.2 ± 0.86 mm for the SDI group (P = 0.06). Conclusion: Five‐year data indicate that FPD treatment in posterior mandibular and maxillary jaws with NDIs was as reliable as with SDIs, although NDIs showed a higher risk of prosthetic complications.     

Success,clinical performance and patient satisfaction of direct fibre‐reinforced composite fixed partial dentures – a two‐year clinical study

To evaluate the success, clinical performance and patient satisfaction of directly placed fibre‐reinforced composite (FRC) fixed partial dentures (FPDs) in 2 years. One hundred sixty‐seven FRC FPDs (120 subjects) were directly fabricated to restore a single missing tooth by six Advanced Education in General Dentistry (AEGD) residents. The FRC FPDs recipients were rando‐mised into two groups according to the fibre materials (pre‐impregnated glass or polyethylene). Clinical performance was evaluated at baseline (2 weeks), 6, 12 and 24 months by two calibrated evaluators for prosthesis adaptation, colour match, marginal discoloration, surface roughness, caries and post‐operative sensitivity using modified United State Public Health Service (USPHS) criteria. Prosthesis appearance, colour, chewing ability and overall satisfaction were evaluated by patients using a visual analogue scale (VAS). Kaplan–Meier estimation was used to estimate the prosthesis success. Ninety‐four patients with 137 FRC FPDs returned (21·67% attrition rate for study subjects, 17·94% for FRC FPDs). Seventeen FRC FPDs failed, due to one‐end (n = 4) or two‐ends (n = 4) debonding or pontic fracture (n = 9). The cumu‐lative 2‐year success rate was 84·32% and survival rate was 92·7%; there were no statistically significant differences between the groups according to different missing tooth location, retention type or fibre materials (P > 0·05). Patient satisfaction regarding prosthesis appearance, col‐our, chewing ability and overall satisfaction was rated high on the VAS (mean >80 mm) for all criteria at all time points. The FRC FPDs (restoring single tooth) fabricated by AEGD residents achieved acceptable success and survival rates in a 2‐year follow‐up.     

Masticatory and nutritional aspects on fixed and removable partial dentures

The aim of the present study was to evaluate mastication, food selection and nutritional aspects in two groups of persons restored with fixed (FPD, N=44) and removable (RPD, N=40) partial dentures respectively. The subjects were part of a cohort study of 67–68-year-old men living in Malmö, Sweden. The two groups were very similar regarding social factors and the inclusion criteria were chosen so that the groups were very equal regarding oral factors, apart from the difference in fixed and removable partial dentures. The number of natural teeth, number of replaced teeth and occlusal contacts did not differ significantly between the two groups, nor did the distribution of maxillary and mandibular dentures. A comprehensive examination of several general health factors included a home interview of dietary habits. A clinical examination included a 20-minute oral examination with registration of number of teeth, FPDs, RPDs, and occlusal contacts. It also included masticatory tests: chewing gum colour mixing, chewing gum bolus shaping, and swallowing threshold (number of strokes to the first swallow of an almond). The consumption of hard and soft foods was revealed by the dietary interview as well as the intake of energy and some nutrients. There was a significant difference between the groups regarding the capacity to mix the two-coloured chewing gum, to shape the chewing gum bolus and in the consumption of hard foods. There was no difference in the swallowing threshold and the consumption of soft foods. The intake of energy and nutrients did not differ significantly between the groups. The differences in masticatory capacity found thus seem to have little, if any, effect on the factors of importance for general health. A reasonable explanation for the differences found is that artificial teeth that are well retained, such as FPDs, make more active chewing possible than do removable, and often somewhat loose-fitting partial dentures.     

Three-dimensional force measurements on mandibular implants supporting overdentures.

The purpose of this study was to determine masticatory and functional forces in three axes on mandibular implants supporting overdentures. Five edentulous test subjects were selected, each having two mandibular implants. Three-dimensional piezoelectric force transducers were mounted on the two-part ITI Bonefit implants and rigidly connected to the denture. Forces in vertical, lateromedial, and anteroposterior directions were measured by means of electrostatic plotter records. The test modalities were light tapping, grinding, maximal occlusal force, and chewing test food. Results showed that the five subjects developed similar stress patterns but quantitatively different occlusal and chewing forces. In all but one subject, reduced maximal occlusal force was found compared to dentate subjects and edentulous subjects with fixed partial prostheses supported by implants. The recordings of chewing cycles when eating test food resulted in very regular rhythmic strokes, similar to those of dentate subjects but with slightly reduced speed. All stress patterns showed that occlusal and chewing forces were mainly directed in vertical, medial, and anterior dimensions. The dominating component was vertical.     

Evaluation of the fit and strength of an all-ceramic fixed partial denture

A laboratory investigation of the fit and strength of three-unit all-ceramic FPDs was performed with a metal-ceramic FPD control. The conclusions were: 1. No difference was found between the marginal seal of the metal-ceramic and all-ceramic FPDs. 2. The all-ceramic FPDs had a more uniform cement space and their occlusal seat was significantly (99.9%) better than the metal-ceramic restorations. 3. The metal-ceramic FPDs were significantly stronger than the all-ceramic FPDs. 4. Load calculations suggest that short-span all-ceramic FPDs may be strong enough to resist normal masticatory forces for selected patients. However, generalized usage will probably result in an unacceptable failure rate.     

The influence of partial implant‐supported restorations on chewing side preference

Summary This study aimed at determining whether the individual’s chewing side preference is affected by local effects, produced by the presence of implant‐supported restorations. The test group included 81 patients with partial implant‐supported prosthesis. The control group included 108 subjects with no implants. All subjects went through a series of laterality tests for chewing and tasks (hand, foot, eye and ear) side preference. The preferred chewing side (PCS) was determined by observing the first stroke of the chewing cycle during chewing a gum. A positive and significant correlation between the chewing side preference and the subject’s sidedness during the different tasks was examined, by performing four Phi correlation tests for: chewing and handedness(r = 0·54; P < 0·001); chewing and footedness (r = 0·49; P < 0·001); chewing and eyedness (r = 0·65; P < 0·001) and chewing and earedness (r = 0·66, P < 0·001). Of the subjects, 78·3% preferred the right side for chewing, 19·1% preferred the left and 2·1% had no clear side preference. There was no statistical difference in chewing side preference distribution between genders. The distribution of chewing side preference was not significantly affected by the location of missing teeth or implants. In conclusion, implant placement will not affect PCS. Therefore, information on chewing side preference should be part of the routine preoperative examination for implant‐supported restorations to provide a better treatment plan in those cases that the implant‐supported restoration will be on the PCS.     

Measurement of masticatory forces and implant loads: a methodologic clinical study

PURPOSE: The aim of this study was to measure vertical masticatory forces in vivo using a method that should be insensitive to the location of bite force impact. MATERIALS AND METHODS: Two exchangeable implant abutments were equipped with strain gauges. In nine patients, the abutments were attached to implants supporting three-unit fixed partial dentures (FPD) in one mandibular chewing center. The signals of the two abutments were summed to give a force reading that was independent of the location of force impact along the FPD. In two subjects, an additional strain gauge was fixed under the pontic. With both setups, masticatory forces were measured in chewing of winegum. RESULTS: Total masticatory force displayed by the sum signal proved to be independent of the site of force application. Pontic strain gauges indicated only 42% or 84% of the force measured simultaneously by the corresponding sum signal of the abutments. In all nine patients, a mean total masticatory force of 220 N, with a maximum of 450 N, was found. The single abutments experienced mean loads of 91 N (anterior) and 129 N (posterior), with a maximum of 314 N. CONCLUSION: Measuring chewing force via bending of a pontic involves the risk of underestimation. Masticatory forces obtained with a method that was insensitive to the site of force application were higher than forces found with some other setups.     

Influence of stress simulation parameters on the fracture strength of all-ceramic fixed-partial dentures.

OBJECTIVES: This in vitro study tested the influence of diverse stress simulation parameters on the fracture strength of all-ceramic three-unit fixed partial dentures (FPDs). METHODS: All-ceramic FPDs made of Empress 2 (Ivoclar-Vivadent, FL) were exposed to thermal cycling and mechanical loading (TCML) with varying loading parameters such as chewing force (amount, frequency), thermal loading, lateral jaw motion, abutment material, artificial periodontium or antagonistic denture. To investigate the influence of the abutment material, human teeth, polymer abutments and alloy abutments were used. Two different TCML devices with pneumatic or weight loading were compared. FPDs without aging were used as a control. RESULTS AND SIGNIFICANCE: Combined thermal and mechanical loading significantly reduced the FPD fracture resistance from 1832N to 410N. Duplication of chewing frequency, phase load increase or additional lateral movement did not effect the results. Increasing chewing force, artificial periodontium, and antagonist or abutment material reduced the fracture resistance of the tested FPDs. Different devices with weight or pneumatic loading had no significant influence on the loading capacity of the FPDs. Artificial aging should be performed combining thermal cycling with mechanical loading. Simulation of the artificial periodontium, human antagonists and abutments should be included to achieve a significant aging.     

Four-year clinical performance of a lithia disilicate-based core ceramic for posterior fixed partial dentures

PURPOSE: The objective of this research was to test the hypothesis that 3-unit fixed partial dentures (FPDs) made from a moderately high-strength core ceramic will adequately resist fracture in posterior regions if fabricated with a minimal connector size of 4 mm. MATERIALS AND METHODS: Thirty ceramic FPD core frameworks were prepared using a hot-pressing technique and a lithia disilicate-based core ceramic. The maximum occlusal force was measured for each patient prior to tooth preparation. Connector heights and widths were measured for each FPD. Patients were recalled annually after cementation for 4 years and evaluated using 11 clinical criteria. All FPDs were examined by 2 independent clinicians, and rankings for each criterion were made from 1 to 4 (4 = excellent; 1 = unacceptable). RESULTS: The fracture rate was approximately 3% per year, and the proportion of good overall ratings in the nonfractured FPDs was reduced by more than 6% per year, where a good overall rating was defined to be a rank of 3 or 4 in all 11 criteria. There was little evidence that the use of either resin-reinforced glass-ionomer cement (Protec CEM) or dual-cure resin cement (Variolink II) made any difference in terms of fracture rate or overall rating (P= .30, .63, .97, and .71 for the 4 years, respectively). From a fracture resistance perspective, 4 of the 30 ceramic FPDs fractured within the 4-year evaluation period, representing an 86.7% success rate. Another FPD was replaced because of a caries lesion on 1 abutment tooth away from the margin. One FPD fracture was associated with the subject having the greatest occlusal force (1,031 N). The other 2 fractures were associated with FPDs that exhibited connector heights of less than 3 mm. All criteria were ranked good to excellent during the 4-year period for the remaining FPDs. CONCLUSION: Fractured FPDs were associated with a connector height of less than 4 mm; thus, the hypothesis was accepted.     

Prevalence of single crowns and fixed partial dentures in elderly citizens in the southern and northern parts of Finland

Summary The epidemiology of oral rehabilitation using fixed prosthodontics has received little attention. The aim of this study was to evaluate the prevalence of single crowns, fixed partial dentures (FPDs), resin‐bonded FPDs and implants in elderly Finnish patients and to identify factors that might be associated with the findings. The survey was carried out in the southern and northern parts of Finland. The target population consisted of all persons born in 1919, 1922, 1925, 1928, 1931, 1934 and 1937, who lived in Kirkkonummi and in Lakeus (n = 1733) in 1996. The age range of the subjects was 60–78 years. In addition to a clinical examination, panoramic radiograph was taken. Data on background factors were obtained using questionnaires and/or interviews. The presence of single crowns, FPDs, resin‐bonded FPDs and implants were determined from the panoramic radiographs. Overall, 12·4% of men and 12·1% of women had single crowns, while 4·8% of men and 8·0% of women had FPDs. A logistic regression analysis showed that the presence of crowns and FPDs was significantly associated with a southern place of residence, high and middle levels of education and high frequency of dental visits.     

Bone level changes at axial- and non-axial-positioned implants supporting fixed partial dentures. A 5-year retrospective longitudinal study

AIM: The aim of this study was to retrospectively analyze the potential influence of implant inclination on marginal bone loss at freestanding, implant-supported, fixed partial dentures (FPDs) over a 5-year period of functional loading. MATERIAL AND METHODS: The material comprised 38 periodontally treated, partially dentate patients with a total of 42 free-standing FPDs supported by implants of the Astra Tech System. Mesio-distal inclination of the implants in relation to a vertical axis perpendicular to the occlusal plane was measured with a protractor on standardized photographs of the master cast. The two tail quartiles of the distribution of the implants with regard to the implant inclination were defined as axial-positioned (mean 2.4 degrees; range 0-4 degrees) and non-axial-positioned implants (mean 17.1 degrees; range 11-30 degrees), respectively. For FPDs supported by two implants, both the mesial-distal and buccal-lingual inter-implant inclination was measured. The primary outcome variable was change in peri-implant bone level from the time of FPD placement to the 5-year follow-up examination. Comparison between axial- and non-axial-positioned implants was performed by the use of a Mann-Whitney U-test. Spearman's correlation analysis was used to analyze relationships between inter-implant inclination (mesial-distal and buccal-lingual) and 5-year bone level change on the FPD level. RESULTS: The 5-year mean bone level change amounted to 0.4 mm (SD 0.97) for the axial and 0.5 mm (0.95) for non-axial-positioned implants (P>0.05). For the FPDs supported by two implants, the mean inter-implant inclination was 9.2 degrees (1-36 degrees) in the mesial-distal direction and 6.7 degrees (0-24 degrees) in the buccal-lingual direction. Correlation analysis revealed lack of statistically significant correlation between inter-implant inclination (mesial-distal and buccal-lingual) and 5-year bone level change (r=-0.19 and r=-0.32, respectively). CONCLUSION: The study failed to support the hypothesis that implant inclination has an effect on peri-implant bone loss.     

Influence of intra‐oral sensory impairment by anaesthesia on food comminution and mixing in dentate subjects

Sensory input from sensory receptors regarding food morsels can affect jaw motor behaviours during mastication. The aim was to clarify the effects of intra‐oral sensory input on the food‐comminuting and food‐mixing capacities of dentate subjects. Eleven dentate subjects without sensory dysfunction in their oro‐facial region participated in this study. Local anaesthesia was achieved on the periodontal structures and on the oral mucosa of the subjects' preferred chewing side by injecting a lidocaine solution with adrenalin. At baseline (control) and after anaesthesia, data on the subjects' food‐comminuting and food‐mixing capacities were gathered. The food‐comminuting capacity was quantified by measuring the degree of pulverisation of peanuts (objective hardness; 45·3 [Newton, N]) after a prescribed 20 chewing strokes. The food‐mixing capacity was measured as the degree of immixture of a two‐coloured paraffin wax cube after 10 chewing strokes. Wax cubes of three different hardness levels were used (soft, medium and hard: 20·3, 32·6 and 75·5 [N], respectively) and were chewed in random order. After anaesthesia, the subjects' food‐comminuting capacity significantly decreased (P < 0·001), as did the food‐mixing capacity for each hardness level of the wax cubes (P < 0·01). A significant correlation was observed between the objective hardness values and the anaesthesia effects for the food‐mixing capacity (P < 0·05), indicating that after anaesthesia, deterioration of the mixing capacity increased as the hardness increased. In conclusion, intra‐oral sensory input can affect both food‐comminuting and food‐mixing capacities.     

Daily chewing gum exercise for stabilizing the vertical occlusion

Summary We investigated the effects of a chewing gum exercise program on occlusal conditions and evaluated compliance of subjects. Thirty‐five healthy adult volunteers (26 males and nine females) were asked to chew gum for 10–15 min before or after three meals daily for four weeks. Occlusal conditions were recorded as occlusal parameters, such as occlusal contact area, occlusal contact force, and pressure using dental prescale films. These parameters were evaluated by an Occluzer before the exercise period commenced, after four weeks of exercise, and then one month after the end of the exercise period. These parameters were statistically compared using one‐way ANOVA. We found that: (i) after four weeks of exercise, anterior and posterior occlusal contact areas and forces were significantly (P < 0·05) increased and the increments were significantly (P < 0·05) higher in the anterior occlusal contact area and force than in the posterior occlusal contact area and force, (ii) the anteroposterior ratio of occlusal contact area and force increased, but not markedly, (iii) increased parameters had significantly (P < 0·05) decreased within one month after the end of the four‐week exercise period, (iv) most participants did not complain for discomfort or stress during the exercise. The chewing gum exercise program could increase occlusal contact area and force and also move the anteroposterior occlusal balance forward. Patient compliance with the exercise is likely high enough to keep them exercising.     

Biological and technical complications and failures with fixed partial dentures (FPD) on implants and teeth after four to five years of function

The aim of this study was to compare the frequency of biological and technical complications with fixed partial dentures (FPDs) on implants, teeth and as mixed tooth-implant supported FPDs over 4 to 5 years of function. All implants belonged to the ITI Dental Implant System. Group I-I (implant FPD) included 33 patients with 40 FPDs, group T-T (tooth FPDs) 40 patients with 58 FPDs, group I-T (mixed tooth-implant FPDs) 15 with 18 FPD. Of the bridge abutments 144 were teeth and 105 were implants. The median number of units replaced by the FPDs was 3 (range 2-14). The mean age of the patients was 55.7 years (range 23-83). Complete failures resulted in the loss of one FPD in each group. Two implants were lost due to fracture secondarily to development of a bone defect. One tooth had a vertical fracture and 1 tooth was lost due to periodontitis. Biological complications (peri-implantitis, PPD > or = 5 mm and BOP+) occurred at 9.6% (10) of the implants. This number was, however, reduced to 5% if the threshold for definition of peri-implantitis was set at PPD > or = 6 mm and BOP+. Biological complications occurred in 11.8% (17) of the abutment teeth (NS compared to implants); 2.8% (4) had secondary caries, 4.9% (7) endodontic problems and 4.1% (6) had periodontitis (PPD > or = 5 mm, BOP+). Ten out of 32 patients with a general health problem indicated a biological complication, whereas 9 out of 53 patients with no general health problem had a biological complication (chi 2: NS). Statistically significantly more technical complications were found in FPDs on implants (chi 2, P < or = 0.05). The technical complications were associated with bruxism. Out of 10 bruxers 6 had a technical complication whereas 13 out of 75 non-bruxers had such a complication (chi 2 < or = 0.01). Extensions were associated with more technical complications (13 out of 35 with extensions versus 9 out of 81 without). In conclusion, favourable clinical conditions were found at tooth and implant abutments after 4-5 years of function. Loss of FPD over 4-5 years occurred at a similar rate with mixed, implant or tooth supported reconstructions. Significantly more porcelain fractures were found in FPDs on implants. Impaired general health status was not significantly associated with more biological failures but bruxism as well as extensions were associated with more technical failures.